Notes

Improvement and Validation of the Clinical Pregnancy Failing Forecast Design with regard to Poor Ovarian Responders Throughout IVF/ICSI.
How to cite this article Prabu RN, Kothekar AT. Using Transthoracic Echocardiography to Predict Fluid Responsiveness after Passive Leg Raising Test Caution Needed. Indian J Crit Care Med 2020;24(11)1147-1148.How to cite this article Patel MP, Kute VB, Goswami J, Balwani MR. Hospitals may Become "Disease Hotspots" for COVID-19 amid Shortage of Personal Protective Equipment. Indian J Crit Care Med 2020;24(11)1145-1146.How to cite this article Nair PR, Maitra S, Ray BR, Anand RK, Baidya DK, Subramaniam R. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Predictors of the Early Requirement of Mechanical Ventilation in COVID-19 Patients. Indian J Crit Care Med 2020;24(11)1143-1144.How to cite this article Kayina CA, Maitra S, Anand RK, Ray BR, Baidya DK, Subramaniam R. SARS-CoV-2 Infection Presenting with Hyperglycemia and Ketosis A Case Series of Three Diabetic Patients. Indian J Crit Care Med 2020;24(11)1141-1142.How to cite this article Sarkar S, Khanna P. Eyes Have It From COVID-19 Perspective. Indian J Crit Care Med 2020;24(11)1139-1140.
Mucormycosis is a rare fungal infection affecting immunocompromised patients, with the rhinocerebral variant as the most common presentation.
Garcin syndrome is the progressive involvement of the cranial nerves resulting in total unilateral paralysis of cranial nerves, absence of sensory or motor deficits, and not associated with features of raised intracranial pressure.
We report a case of invasive rhinocerebral mucormycosis presenting as Garcin syndrome and acute ischemic stroke.

Nagendra V, Thakkar KD, Prasad Hrishi A, Prathapadas U. A Rare Case of Rhinocerebral Mucormycosis Presenting as Garcin Syndrome and Acute Ischemic Stroke. Indian J Crit Care Med 2020;24(11)1137-1138.
Nagendra V, Thakkar KD, Prasad Hrishi A, Prathapadas U. A Rare Case of Rhinocerebral Mucormycosis Presenting as Garcin Syndrome and Acute Ischemic Stroke. Indian J Crit Care Med 2020;24(11)1137-1138.Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. We present a 61-year-old uncorrected TOF patient who presented with sepsis and acute respiratory failure. At presentation, the patient had tachypnea, tachycardia, and oxygen saturation (SpO2) 64%. Chest X-ray (CXR) showed bilateral basal opacities. 2D echo revealed left ventricular dysfunction, infundibulum stenosis, pulmonary atresia, overriding of the aorta, and ventricular septal defect. A provisional diagnosis of community-acquired pneumonia with septic shock with uncorrected TOF was made. He received empirical antibiotics, ventilatory support, and supportive care. Ventilator weaning was done accepting an arbitrary baseline SpO2 of 70-75% and lactate-guided volume resuscitation led to a successful outcome. Coronary angiogram showed collaterals. This case report illustrates the dilemmas faced in treating a critically ill uncorrected TOF. To the best of our knowledge, this case could be the oldest surviving uncorrected TOF patient in the Indian population.
Prakash SY, Kartik M, Rao M, Harde YR. Challenges Faced in Managing an Adult Uncorrected Tetralogy of Fallot Patient with Pneumonia and Septic Shock in the Intensive Care Unit. Indian J Crit Care Med 2020;24(11)1135-1136.
Prakash SY, Kartik M, Rao M, Harde YR. Challenges Faced in Managing an Adult Uncorrected Tetralogy of Fallot Patient with Pneumonia and Septic Shock in the Intensive Care Unit. Indian J Crit Care Med 2020;24(11)1135-1136.COVID pneumonia patient presents with fever, cough, and breathing difficulty. Many respiratory pathogens have such clinical presentations and pulmonary tuberculosis (PTB) is one of them, which is prevalent in the Indian subcontinent. Herein, we are presenting a case of dual infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and drug-resistant PTB [likely multidrug resistance (MDR)] in a patient with chronic kidney disease (CKD) and type 2 diabetes mellitus, a clinical course further complicated by a prolonged viral clearance.
Sarma U, Mishra V, Goel J, Yadav S, Sharma S, Sherawat RK. COVID-19 Pneumonia with Delayed Viral Clearance in a Patient with Active Drug-resistant Pulmonary Tuberculosis. Indian J Crit Care Med 2020;24(11)1132-1134.
Sarma U, Mishra V, Goel J, Yadav S, Sharma S, Sherawat RK. COVID-19 Pneumonia with Delayed Viral Clearance in a Patient with Active Drug-resistant Pulmonary Tuberculosis. ML-SI3 concentration Indian J Crit Care Med 2020;24(11)1132-1134.
Patient-ventilator dyssynchrony is commonly due to patient pathophysiologic factors and imprecise ventilator settings. In unusual circumstances, such dyssynchrony can also be due to faults within the equipment preventing from its normal operation during assisted mechanical ventilation.

We report a patient showing an unusual pattern of dyssynchronous breathing related to a blocked scavenging system caused by the failure of its rod valve to open. Collection of water condensate inside its reservoir bag leading to a weight drag and deformation of its shape was found to be the cause. Specifically, our patient manifested as failure to trigger with the development of high positive end-expiratory pressure (PEEP) and paradoxical pressure changes during pressure support ventilation.

Water condensation distal to the ventilator exhaust gas outlet may not be immediately apparent. Clinicians should remain alert with patient-ventilator dyssynchrony, especially with an unusual pattern, as it may signify equipment faults, such as expiratory gas flow obstruction within the scavenging system.

Chan KM, Ng YC, So HY. An Unusual Pattern of Dyssynchronous Breathing due to Expiratory Flow Obstruction in the Scavenging System Caused by the Weight of Water Condensate. Indian J Crit Care Med 2020;24(11)1128-1131.
Chan KM, Ng YC, So HY. An Unusual Pattern of Dyssynchronous Breathing due to Expiratory Flow Obstruction in the Scavenging System Caused by the Weight of Water Condensate. Indian J Crit Care Med 2020;24(11)1128-1131.R0 (R naught) is the basic reproduction number, also known as basic reproduction ratio or rate which is an epidemiological metric used to measure the transmissibility of infectious agents. R0 is a derivative of the following variables-the duration of infectivity after the patient gets infected, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual, and the contact rate. R0 is usually estimated retrospectively from serial epidemiological data or using theoretical mathematical models. Epidemiologists can calculate R0 using contact-tracing data, the most common method is to use cumulative incidence data. When mathematical models are used, R0 values are estimated using ordinary differential equations. R0 of COVID-19 as initially estimated by the World Health Organization (WHO) was between 1.4 and 2.4. The forecast is of critical importance as it will help the governments to have an estimate as well as strategize quickly to avoid any unfavorable condition.
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